Heidi Splete

DENVER – Phobic anxiety was significantly associated with both ventricular arrhythmia and mortality in coronary artery disease patients during a median 3-year follow-up, said Lana Watkins, Ph.D., at the annual meeting of the American Psychosomatic Society.

The relationship between sudden cardiac death and phobic anxiety in particular has not been well studied, Dr. Watkins noted. She and her colleagues at Duke University Medical Center in Durham, N.C., evaluated 941 adult patients who were being treated for coronary artery disease. A majority of these patients were white males. About a third of the patients did not have high school diplomas, and smoking and obesity were common among patients in the study.

The highest number of arrhythmias occurred among those patients with the highest levels of phobic anxiety based on the Crown-Crisp index, which rates eight types of phobias, including fear of heights, crowds, and closed spaces.

Overall, the highest tertile of phobic anxiety scores had twice as many females as males, and a higher level of phobic anxiety was significantly associated with female sex, minority status, increased body mass index, and younger age.

Despite the finding of an association between phobic anxiety and ventricular arrhythmias, no significant relationship was found between phobic anxiety and sudden cardiac death, Dr. Watkins noted. During a follow-up period, 134 patients died, and 46 of these met the criteria for sudden cardiac death. Sudden cardiac death was defined as death within 72 hours of collapse, in order to account for deaths of patients who lived alone.

However, mortality was highest among patients with high levels of phobic anxiety, Dr. Watkins said. The predictability of phobic anxiety for both mortality and an increased risk of ventricular arrhythmias was maintained in a regression analysis after other predictors of mortality including age, gender, education level, and comorbidities were adjusted for.

DENVER – Phobic anxiety was significantly associated with both ventricular arrhythmia and mortality in coronary artery disease patients during a median 3-year follow-up, said Lana Watkins, Ph.D., at the annual meeting of the American Psychosomatic Society.

The relationship between sudden cardiac death and phobic anxiety in particular has not been well studied, Dr. Watkins noted. She and her colleagues at Duke University Medical Center in Durham, N.C., evaluated 941 adult patients who were being treated for coronary artery disease. A majority of these patients were white males. About a third of the patients did not have high school diplomas, and smoking and obesity were common among patients in the study.

The highest number of arrhythmias occurred among those patients with the highest levels of phobic anxiety based on the Crown-Crisp index, which rates eight types of phobias, including fear of heights, crowds, and closed spaces.

Overall, the highest tertile of phobic anxiety scores had twice as many females as males, and a higher level of phobic anxiety was significantly associated with female sex, minority status, increased body mass index, and younger age.

Despite the finding of an association between phobic anxiety and ventricular arrhythmias, no significant relationship was found between phobic anxiety and sudden cardiac death, Dr. Watkins noted. During a follow-up period, 134 patients died, and 46 of these met the criteria for sudden cardiac death. Sudden cardiac death was defined as death within 72 hours of collapse, in order to account for deaths of patients who lived alone.

However, mortality was highest among patients with high levels of phobic anxiety, Dr. Watkins said. The predictability of phobic anxiety for both mortality and an increased risk of ventricular arrhythmias was maintained in a regression analysis after other predictors of mortality including age, gender, education level, and comorbidities were adjusted for.

DENVER – Phobic anxiety was significantly associated with both ventricular arrhythmia and mortality in coronary artery disease patients during a median 3-year follow-up, said Lana Watkins, Ph.D., at the annual meeting of the American Psychosomatic Society.

The relationship between sudden cardiac death and phobic anxiety in particular has not been well studied, Dr. Watkins noted. She and her colleagues at Duke University Medical Center in Durham, N.C., evaluated 941 adult patients who were being treated for coronary artery disease. A majority of these patients were white males. About a third of the patients did not have high school diplomas, and smoking and obesity were common among patients in the study.

The highest number of arrhythmias occurred among those patients with the highest levels of phobic anxiety based on the Crown-Crisp index, which rates eight types of phobias, including fear of heights, crowds, and closed spaces.

Overall, the highest tertile of phobic anxiety scores had twice as many females as males, and a higher level of phobic anxiety was significantly associated with female sex, minority status, increased body mass index, and younger age.

Despite the finding of an association between phobic anxiety and ventricular arrhythmias, no significant relationship was found between phobic anxiety and sudden cardiac death, Dr. Watkins noted. During a follow-up period, 134 patients died, and 46 of these met the criteria for sudden cardiac death. Sudden cardiac death was defined as death within 72 hours of collapse, in order to account for deaths of patients who lived alone.

However, mortality was highest among patients with high levels of phobic anxiety, Dr. Watkins said. The predictability of phobic anxiety for both mortality and an increased risk of ventricular arrhythmias was maintained in a regression analysis after other predictors of mortality including age, gender, education level, and comorbidities were adjusted for.

DENVER – End-stage liver disease was associated with significant deficits in memory, abstract thought, sustained attention, and executive function in a study of 104 adult patients, Tina Meyer, Ph.D., reported in a poster presented at the annual meeting of the American Psychosomatic Society.

“We want to enlighten the surgeons and primary care doctors that cognitive decline can indicate serious liver problems,” Dr. Meyer said in an interview. She and her colleagues in the Transplant Institute at the Henry Ford Health System in Detroit enrolled liver disease patients who met medical and psychosocial criteria for a transplant. About half (51%) were male, 74% were white, and the average age was 54 years. The patients' mean score on the model for end-stage liver disease (MELD) was 11.3.

The participants completed a cognitive assessment including the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), which estimates brain function in five different domains: immediate memory, delayed memory, visuospatial abilities, language, and attention.

Overall, scores on the RBANS were below average on the subtests of immediate memory, visuospatial abilities, and attention. After the investigators controlled for education levels, higher MELD scores were significantly associated with lower scores on the immediate memory and delayed memory subtests of RBANS, as well as with lower scores on the Mini-Mental State Exam, the Shipley Institute of Living Scale, and the Trail-Making Test, parts A and B.

DENVER – End-stage liver disease was associated with significant deficits in memory, abstract thought, sustained attention, and executive function in a study of 104 adult patients, Tina Meyer, Ph.D., reported in a poster presented at the annual meeting of the American Psychosomatic Society.

“We want to enlighten the surgeons and primary care doctors that cognitive decline can indicate serious liver problems,” Dr. Meyer said in an interview. She and her colleagues in the Transplant Institute at the Henry Ford Health System in Detroit enrolled liver disease patients who met medical and psychosocial criteria for a transplant. About half (51%) were male, 74% were white, and the average age was 54 years. The patients' mean score on the model for end-stage liver disease (MELD) was 11.3.

The participants completed a cognitive assessment including the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), which estimates brain function in five different domains: immediate memory, delayed memory, visuospatial abilities, language, and attention.

Overall, scores on the RBANS were below average on the subtests of immediate memory, visuospatial abilities, and attention. After the investigators controlled for education levels, higher MELD scores were significantly associated with lower scores on the immediate memory and delayed memory subtests of RBANS, as well as with lower scores on the Mini-Mental State Exam, the Shipley Institute of Living Scale, and the Trail-Making Test, parts A and B.

DENVER – End-stage liver disease was associated with significant deficits in memory, abstract thought, sustained attention, and executive function in a study of 104 adult patients, Tina Meyer, Ph.D., reported in a poster presented at the annual meeting of the American Psychosomatic Society.

“We want to enlighten the surgeons and primary care doctors that cognitive decline can indicate serious liver problems,” Dr. Meyer said in an interview. She and her colleagues in the Transplant Institute at the Henry Ford Health System in Detroit enrolled liver disease patients who met medical and psychosocial criteria for a transplant. About half (51%) were male, 74% were white, and the average age was 54 years. The patients' mean score on the model for end-stage liver disease (MELD) was 11.3.

The participants completed a cognitive assessment including the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), which estimates brain function in five different domains: immediate memory, delayed memory, visuospatial abilities, language, and attention.

Overall, scores on the RBANS were below average on the subtests of immediate memory, visuospatial abilities, and attention. After the investigators controlled for education levels, higher MELD scores were significantly associated with lower scores on the immediate memory and delayed memory subtests of RBANS, as well as with lower scores on the Mini-Mental State Exam, the Shipley Institute of Living Scale, and the Trail-Making Test, parts A and B.

More than 1,000 cases of mumps in nine states have been confirmed in the nation's largest mumps outbreak in decades, announced Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, Atlanta.

The outbreak began in Iowa in December 2005 among college students, whose close living conditions make them susceptible to the virus, Dr. Gerberding said in a press briefing. By comparison, a yearly average of 265 mumps cases have been reported for the entire country since 2001, while Iowa previously averaged just 5 cases per year since 1996, the CDC reported (MMWR [Dispatch] 2006;55:1–3).

“As clinicians become more aware of what we are looking for, we expect more cases will be diagnosed,” Dr. Gerberding said. “A lot of clinicians have never seen a case of mumps. Not everyone presents with swollen glands.”

Most cases occurred in people aged 18–25 years, many of whom had received either one or two doses of the mumps vaccine. Cases are under investigation in Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, Nebraska, and Wisconsin. Dr. Gerberding declined to name additional states in which suspected but unconfirmed cases are under investigation.

In addition, two individuals have been identified in Iowa who were potentially infectious during nine different commercial flights between March 26 and April 2, to or from cities outside the Midwest, including Tucson, Ariz.; Dallas; and Washington, the CDC said in an official health advisory issued on April 14.

Mumps, an acute viral upper respiratory infection, may present initially with nonspecific symptoms such as myalgia, anorexia, malaise, headache, and fever, and progress to acute onset of unilateral or bilateral tenderness and swelling of parotid or other salivary glands. About 30%–70% of unvaccinated people develop typical acute parotitis, but up to 20% of infections are asymptomatic; nearly 50% are associated with nonspecific symptoms or symptoms that are primarily respiratory, with or without parotitis. Severe complications can include deafness, orchitis, oophoritis, mastitis, meningitis/encephalitis, and spontaneous abortion.

Most people with mumps are ill for about a week, and they can be contagious from 3 days before symptoms appear until about 9 days after the appearance of symptoms, according to the CDC.

“It's very important for health care workers to have a second dose of the MMR vaccine,” Dr. Gerberding emphasized.

Health care providers in affected areas are advised to offer the MMR vaccine to individuals without evidence of immunity, including all unvaccinated persons born after 1957. In addition, a second dose is recommended for school-age children, college students, and other high-risk groups. Most children have received both doses, but vaccine coverage rates vary with location and population, Dr. Gerberding said.

The supply of MMR vaccine is adequate to cope with the outbreak, she said. The CDC will assist states with vaccine supplies as needed, and Merck has donated 25,000 doses to the CDC's stockpile.

The problem, Dr. Gerberding said, is a lack of complete coverage with a vaccine that is not 100% effective. About 10% of people who receive both doses simply fail to respond and remain susceptible to mumps.

Individuals suspected to have mumps should be tested and any positive cases reported immediately to local public health officials. Such individuals should be isolated for 9 days after symptom onset, the CDC advised.

Physicians should familiarize themselves with the clinical presentations of mumps, infectious disease specialist Dr. Mary Anne Jackson told this newspaper. Some patients complain of pain at the corner of the jaw, or of an earache that can be confused with otitis. Ovarian inflammation, which may occur in up to 5% of infected postpubertal females, may be confused with appendicitis.

Symptomatic meningitis, which occurs in up to 15% of cases, is associated with a lymphocytic pleocytosis (inflammatory cells in the spinal fluid) that is typical of viral meningitis, but with a low CSF glucose level. Typical summertime enterovirus meningitis is usually associated with normal or low-normal CSF glucose levels, typically around 40%–50% of peripheral glucose. With mumps meningitis, those levels might be 10%–25%. It's important to rule out bacterial meningitis, which a low CSF glucose might suggest, said Dr. Jackson, chief of infectious disease at Children's Mercy Hospital, Kansas City, Mo.

When mumps is suspected, options include culturing the nasopharynx, throat, or urine or testing for serum IgM antibodies. Standard shell vial culture could miss mumps, so ensure that your laboratory's culture will identify mumps, she advised.

At the time of the press briefing, no deaths related to the mumps outbreak had been reported, Dr. Gerberding said. “We hope the containment steps that are being taken at the state levels will help to slow things down,” she said.

Further information from the CDC is available at www.cdc.gov/nip/diseases/mumps/mumps-outbreak.htm

More than 1,000 cases of mumps in nine states have been confirmed in the nation's largest mumps outbreak in decades, announced Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, Atlanta.

The outbreak began in Iowa in December 2005 among college students, whose close living conditions make them susceptible to the virus, Dr. Gerberding said in a press briefing. By comparison, a yearly average of 265 mumps cases have been reported for the entire country since 2001, while Iowa previously averaged just 5 cases per year since 1996, the CDC reported (MMWR [Dispatch] 2006;55:1–3).

“As clinicians become more aware of what we are looking for, we expect more cases will be diagnosed,” Dr. Gerberding said. “A lot of clinicians have never seen a case of mumps. Not everyone presents with swollen glands.”

Most cases occurred in people aged 18–25 years, many of whom had received either one or two doses of the mumps vaccine. Cases are under investigation in Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, Nebraska, and Wisconsin. Dr. Gerberding declined to name additional states in which suspected but unconfirmed cases are under investigation.

In addition, two individuals have been identified in Iowa who were potentially infectious during nine different commercial flights between March 26 and April 2, to or from cities outside the Midwest, including Tucson, Ariz.; Dallas; and Washington, the CDC said in an official health advisory issued on April 14.

Mumps, an acute viral upper respiratory infection, may present initially with nonspecific symptoms such as myalgia, anorexia, malaise, headache, and fever, and progress to acute onset of unilateral or bilateral tenderness and swelling of parotid or other salivary glands. About 30%–70% of unvaccinated people develop typical acute parotitis, but up to 20% of infections are asymptomatic; nearly 50% are associated with nonspecific symptoms or symptoms that are primarily respiratory, with or without parotitis. Severe complications can include deafness, orchitis, oophoritis, mastitis, meningitis/encephalitis, and spontaneous abortion.

Most people with mumps are ill for about a week, and they can be contagious from 3 days before symptoms appear until about 9 days after the appearance of symptoms, according to the CDC.

“It's very important for health care workers to have a second dose of the MMR vaccine,” Dr. Gerberding emphasized.

Health care providers in affected areas are advised to offer the MMR vaccine to individuals without evidence of immunity, including all unvaccinated persons born after 1957. In addition, a second dose is recommended for school-age children, college students, and other high-risk groups. Most children have received both doses, but vaccine coverage rates vary with location and population, Dr. Gerberding said.

The supply of MMR vaccine is adequate to cope with the outbreak, she said. The CDC will assist states with vaccine supplies as needed, and Merck has donated 25,000 doses to the CDC's stockpile.

The problem, Dr. Gerberding said, is a lack of complete coverage with a vaccine that is not 100% effective. About 10% of people who receive both doses simply fail to respond and remain susceptible to mumps.

Individuals suspected to have mumps should be tested and any positive cases reported immediately to local public health officials. Such individuals should be isolated for 9 days after symptom onset, the CDC advised.

Physicians should familiarize themselves with the clinical presentations of mumps, infectious disease specialist Dr. Mary Anne Jackson told this newspaper. Some patients complain of pain at the corner of the jaw, or of an earache that can be confused with otitis. Ovarian inflammation, which may occur in up to 5% of infected postpubertal females, may be confused with appendicitis.

Symptomatic meningitis, which occurs in up to 15% of cases, is associated with a lymphocytic pleocytosis (inflammatory cells in the spinal fluid) that is typical of viral meningitis, but with a low CSF glucose level. Typical summertime enterovirus meningitis is usually associated with normal or low-normal CSF glucose levels, typically around 40%–50% of peripheral glucose. With mumps meningitis, those levels might be 10%–25%. It's important to rule out bacterial meningitis, which a low CSF glucose might suggest, said Dr. Jackson, chief of infectious disease at Children's Mercy Hospital, Kansas City, Mo.

When mumps is suspected, options include culturing the nasopharynx, throat, or urine or testing for serum IgM antibodies. Standard shell vial culture could miss mumps, so ensure that your laboratory's culture will identify mumps, she advised.

At the time of the press briefing, no deaths related to the mumps outbreak had been reported, Dr. Gerberding said. “We hope the containment steps that are being taken at the state levels will help to slow things down,” she said.

Further information from the CDC is available at www.cdc.gov/nip/diseases/mumps/mumps-outbreak.htm

More than 1,000 cases of mumps in nine states have been confirmed in the nation's largest mumps outbreak in decades, announced Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, Atlanta.

The outbreak began in Iowa in December 2005 among college students, whose close living conditions make them susceptible to the virus, Dr. Gerberding said in a press briefing. By comparison, a yearly average of 265 mumps cases have been reported for the entire country since 2001, while Iowa previously averaged just 5 cases per year since 1996, the CDC reported (MMWR [Dispatch] 2006;55:1–3).

“As clinicians become more aware of what we are looking for, we expect more cases will be diagnosed,” Dr. Gerberding said. “A lot of clinicians have never seen a case of mumps. Not everyone presents with swollen glands.”

Most cases occurred in people aged 18–25 years, many of whom had received either one or two doses of the mumps vaccine. Cases are under investigation in Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, Nebraska, and Wisconsin. Dr. Gerberding declined to name additional states in which suspected but unconfirmed cases are under investigation.

In addition, two individuals have been identified in Iowa who were potentially infectious during nine different commercial flights between March 26 and April 2, to or from cities outside the Midwest, including Tucson, Ariz.; Dallas; and Washington, the CDC said in an official health advisory issued on April 14.

Mumps, an acute viral upper respiratory infection, may present initially with nonspecific symptoms such as myalgia, anorexia, malaise, headache, and fever, and progress to acute onset of unilateral or bilateral tenderness and swelling of parotid or other salivary glands. About 30%–70% of unvaccinated people develop typical acute parotitis, but up to 20% of infections are asymptomatic; nearly 50% are associated with nonspecific symptoms or symptoms that are primarily respiratory, with or without parotitis. Severe complications can include deafness, orchitis, oophoritis, mastitis, meningitis/encephalitis, and spontaneous abortion.

Most people with mumps are ill for about a week, and they can be contagious from 3 days before symptoms appear until about 9 days after the appearance of symptoms, according to the CDC.

“It's very important for health care workers to have a second dose of the MMR vaccine,” Dr. Gerberding emphasized.

Health care providers in affected areas are advised to offer the MMR vaccine to individuals without evidence of immunity, including all unvaccinated persons born after 1957. In addition, a second dose is recommended for school-age children, college students, and other high-risk groups. Most children have received both doses, but vaccine coverage rates vary with location and population, Dr. Gerberding said.

The supply of MMR vaccine is adequate to cope with the outbreak, she said. The CDC will assist states with vaccine supplies as needed, and Merck has donated 25,000 doses to the CDC's stockpile.

The problem, Dr. Gerberding said, is a lack of complete coverage with a vaccine that is not 100% effective. About 10% of people who receive both doses simply fail to respond and remain susceptible to mumps.

Individuals suspected to have mumps should be tested and any positive cases reported immediately to local public health officials. Such individuals should be isolated for 9 days after symptom onset, the CDC advised.

Physicians should familiarize themselves with the clinical presentations of mumps, infectious disease specialist Dr. Mary Anne Jackson told this newspaper. Some patients complain of pain at the corner of the jaw, or of an earache that can be confused with otitis. Ovarian inflammation, which may occur in up to 5% of infected postpubertal females, may be confused with appendicitis.

Symptomatic meningitis, which occurs in up to 15% of cases, is associated with a lymphocytic pleocytosis (inflammatory cells in the spinal fluid) that is typical of viral meningitis, but with a low CSF glucose level. Typical summertime enterovirus meningitis is usually associated with normal or low-normal CSF glucose levels, typically around 40%–50% of peripheral glucose. With mumps meningitis, those levels might be 10%–25%. It's important to rule out bacterial meningitis, which a low CSF glucose might suggest, said Dr. Jackson, chief of infectious disease at Children's Mercy Hospital, Kansas City, Mo.

When mumps is suspected, options include culturing the nasopharynx, throat, or urine or testing for serum IgM antibodies. Standard shell vial culture could miss mumps, so ensure that your laboratory's culture will identify mumps, she advised.

At the time of the press briefing, no deaths related to the mumps outbreak had been reported, Dr. Gerberding said. “We hope the containment steps that are being taken at the state levels will help to slow things down,” she said.

Further information from the CDC is available at www.cdc.gov/nip/diseases/mumps/mumps-outbreak.htm

ATLANTA — As summer approaches, it may be wise to be wary of berries. Five norovirus outbreaks affecting several hundred people in Denmark in 2005 were traced to a single batch of contaminated frozen raspberries, Dr. Gerhard Falkenhorst reported at the International Conference on Emerging Infectious Diseases.

The first cases of illness in each outbreak appeared within 24 hours after the patients ate a raspberry dessert, and norovirus was detected in stool samples from all but one outbreak, said Dr. Falkenhorst, of the Statens Serum Institut, Copenhagen.

The outbreaks occurred between May and September 2005, and all of them involved mass catering settings—one hospital, one “meals-on-wheels” service, one restaurant, and two nursing homes. All of the outbreaks involved desserts made with frozen raspberries.

The first outbreak occurred in a hospital, and both patients and staff members reported acute gastroenteritis. Ultimately, nearly 450 cases occurred in this outbreak. Several cases occurred simultaneously, which suggested a foodborne cause, and norovirus was discovered in food tracings that implicated a dessert made with raspberries that were part of a single, large shipment from Poland.

Although the supplier began a voluntary recall of the shipment, the affected raspberries had already been sent to other clients and were linked to several other outbreaks.

The second outbreak affected about 70 residents and staff members at a nursing home the day after a raspberry dessert had been served, and the third outbreak struck several hundred clients of a “meals-on-wheels” service, which reported diarrhea and vomiting among its clients within 2 days after they had received raspberry desserts. The attack rate was especially high among patients aged 85 years and older, Dr. Falkenhorst noted.

A case-control study confirmed that all the desserts associated with the outbreaks were prepared with crushed, frozen raspberries from the same batch imported from Poland. The same norovirus genogroup (II.7) was identified in 24 of 54 stool samples from one outbreak and 9 of 11 stool samples from the second outbreak. Also, norovirus genogroup II.4 was found in 15 of 15 samples from a third outbreak and genogroup II.b was found in 4 of 8 samples from another outbreak.

This series is the first time several norovirus strains were found in stool samples involving the same raspberry vehicle, Dr. Falkenhorst noted.

ATLANTA — As summer approaches, it may be wise to be wary of berries. Five norovirus outbreaks affecting several hundred people in Denmark in 2005 were traced to a single batch of contaminated frozen raspberries, Dr. Gerhard Falkenhorst reported at the International Conference on Emerging Infectious Diseases.

The first cases of illness in each outbreak appeared within 24 hours after the patients ate a raspberry dessert, and norovirus was detected in stool samples from all but one outbreak, said Dr. Falkenhorst, of the Statens Serum Institut, Copenhagen.

The outbreaks occurred between May and September 2005, and all of them involved mass catering settings—one hospital, one “meals-on-wheels” service, one restaurant, and two nursing homes. All of the outbreaks involved desserts made with frozen raspberries.

The first outbreak occurred in a hospital, and both patients and staff members reported acute gastroenteritis. Ultimately, nearly 450 cases occurred in this outbreak. Several cases occurred simultaneously, which suggested a foodborne cause, and norovirus was discovered in food tracings that implicated a dessert made with raspberries that were part of a single, large shipment from Poland.

Although the supplier began a voluntary recall of the shipment, the affected raspberries had already been sent to other clients and were linked to several other outbreaks.

The second outbreak affected about 70 residents and staff members at a nursing home the day after a raspberry dessert had been served, and the third outbreak struck several hundred clients of a “meals-on-wheels” service, which reported diarrhea and vomiting among its clients within 2 days after they had received raspberry desserts. The attack rate was especially high among patients aged 85 years and older, Dr. Falkenhorst noted.

A case-control study confirmed that all the desserts associated with the outbreaks were prepared with crushed, frozen raspberries from the same batch imported from Poland. The same norovirus genogroup (II.7) was identified in 24 of 54 stool samples from one outbreak and 9 of 11 stool samples from the second outbreak. Also, norovirus genogroup II.4 was found in 15 of 15 samples from a third outbreak and genogroup II.b was found in 4 of 8 samples from another outbreak.

This series is the first time several norovirus strains were found in stool samples involving the same raspberry vehicle, Dr. Falkenhorst noted.

ATLANTA — As summer approaches, it may be wise to be wary of berries. Five norovirus outbreaks affecting several hundred people in Denmark in 2005 were traced to a single batch of contaminated frozen raspberries, Dr. Gerhard Falkenhorst reported at the International Conference on Emerging Infectious Diseases.

The first cases of illness in each outbreak appeared within 24 hours after the patients ate a raspberry dessert, and norovirus was detected in stool samples from all but one outbreak, said Dr. Falkenhorst, of the Statens Serum Institut, Copenhagen.

The outbreaks occurred between May and September 2005, and all of them involved mass catering settings—one hospital, one “meals-on-wheels” service, one restaurant, and two nursing homes. All of the outbreaks involved desserts made with frozen raspberries.

The first outbreak occurred in a hospital, and both patients and staff members reported acute gastroenteritis. Ultimately, nearly 450 cases occurred in this outbreak. Several cases occurred simultaneously, which suggested a foodborne cause, and norovirus was discovered in food tracings that implicated a dessert made with raspberries that were part of a single, large shipment from Poland.

Although the supplier began a voluntary recall of the shipment, the affected raspberries had already been sent to other clients and were linked to several other outbreaks.

The second outbreak affected about 70 residents and staff members at a nursing home the day after a raspberry dessert had been served, and the third outbreak struck several hundred clients of a “meals-on-wheels” service, which reported diarrhea and vomiting among its clients within 2 days after they had received raspberry desserts. The attack rate was especially high among patients aged 85 years and older, Dr. Falkenhorst noted.

A case-control study confirmed that all the desserts associated with the outbreaks were prepared with crushed, frozen raspberries from the same batch imported from Poland. The same norovirus genogroup (II.7) was identified in 24 of 54 stool samples from one outbreak and 9 of 11 stool samples from the second outbreak. Also, norovirus genogroup II.4 was found in 15 of 15 samples from a third outbreak and genogroup II.b was found in 4 of 8 samples from another outbreak.

This series is the first time several norovirus strains were found in stool samples involving the same raspberry vehicle, Dr. Falkenhorst noted.

ATLANTA — About 80% of Salmonella cases in the United States in 2004 and 2005 were domestically acquired isolated incidents, Dina Hoefer reported in a poster presented at the International Conference on Emerging Infectious Diseases.

In contrast, about 12% of infected patients with known travel status had traveled internationally, and almost 8% of cases were associated with a recognized outbreak, based on data from the Foodborne Diseases Active Surveillance Network (FoodNet).

FoodNet is a program supported by the CDC, the U.S. Department of Agriculture, and the FDA; it seeks to link foodborne illnesses to specific foods and settings based on data from 10 U.S. sites.

Ms. Hoefer, of the New York Department of Health in Albany, and her colleagues reviewed FoodNet surveillance data for 12,159 cases of Salmonella infection from 2004 and 2005. Of the 7,500 patients whose travel status and outbreak associations were known, 878 had traveled internationally within 7 days prior to illness onset, and 583 were known to be part of a documented Salmonella outbreak.

Overall, the isolated domestically acquired cases were significantly more likely to require hospitalization, compared with travel-related cases (relative risk 1.5) or cases associated with outbreaks (RR 1.4). The most common serotypes among all cases were S. enteritidis and S. typhimurium, but S. enteritidis accounted for a significantly higher proportion of travel-related cases, compared with S. typhimurium (35% vs. 9%).

In addition, isolated domestically acquired cases were more likely than outbreak-associated cases but less likely than travel-related cases to have Salmonella isolates in the blood or cerebrospinal fluid.

ATLANTA — About 80% of Salmonella cases in the United States in 2004 and 2005 were domestically acquired isolated incidents, Dina Hoefer reported in a poster presented at the International Conference on Emerging Infectious Diseases.

In contrast, about 12% of infected patients with known travel status had traveled internationally, and almost 8% of cases were associated with a recognized outbreak, based on data from the Foodborne Diseases Active Surveillance Network (FoodNet).

FoodNet is a program supported by the CDC, the U.S. Department of Agriculture, and the FDA; it seeks to link foodborne illnesses to specific foods and settings based on data from 10 U.S. sites.

Ms. Hoefer, of the New York Department of Health in Albany, and her colleagues reviewed FoodNet surveillance data for 12,159 cases of Salmonella infection from 2004 and 2005. Of the 7,500 patients whose travel status and outbreak associations were known, 878 had traveled internationally within 7 days prior to illness onset, and 583 were known to be part of a documented Salmonella outbreak.

Overall, the isolated domestically acquired cases were significantly more likely to require hospitalization, compared with travel-related cases (relative risk 1.5) or cases associated with outbreaks (RR 1.4). The most common serotypes among all cases were S. enteritidis and S. typhimurium, but S. enteritidis accounted for a significantly higher proportion of travel-related cases, compared with S. typhimurium (35% vs. 9%).

In addition, isolated domestically acquired cases were more likely than outbreak-associated cases but less likely than travel-related cases to have Salmonella isolates in the blood or cerebrospinal fluid.

ATLANTA — About 80% of Salmonella cases in the United States in 2004 and 2005 were domestically acquired isolated incidents, Dina Hoefer reported in a poster presented at the International Conference on Emerging Infectious Diseases.

In contrast, about 12% of infected patients with known travel status had traveled internationally, and almost 8% of cases were associated with a recognized outbreak, based on data from the Foodborne Diseases Active Surveillance Network (FoodNet).

FoodNet is a program supported by the CDC, the U.S. Department of Agriculture, and the FDA; it seeks to link foodborne illnesses to specific foods and settings based on data from 10 U.S. sites.

Ms. Hoefer, of the New York Department of Health in Albany, and her colleagues reviewed FoodNet surveillance data for 12,159 cases of Salmonella infection from 2004 and 2005. Of the 7,500 patients whose travel status and outbreak associations were known, 878 had traveled internationally within 7 days prior to illness onset, and 583 were known to be part of a documented Salmonella outbreak.

Overall, the isolated domestically acquired cases were significantly more likely to require hospitalization, compared with travel-related cases (relative risk 1.5) or cases associated with outbreaks (RR 1.4). The most common serotypes among all cases were S. enteritidis and S. typhimurium, but S. enteritidis accounted for a significantly higher proportion of travel-related cases, compared with S. typhimurium (35% vs. 9%).

In addition, isolated domestically acquired cases were more likely than outbreak-associated cases but less likely than travel-related cases to have Salmonella isolates in the blood or cerebrospinal fluid.

ATLANTA — Just when you thought that prepackaged deli meat was safe, a gastroenteritis outbreak among river rafters in Colorado was traced to norovirus in prepackaged chicken and beef, Dr. Ezra J. Barzilay said at the International Conference on Emerging Infectious Diseases.

On Sept. 18, 2005, the National Park Service contacted the Centers for Disease Control and Prevention to report an outbreak of 136 cases of gastroenteritis in 3 weeks among rafters who participated in group trips on the Colorado River, said Dr. Barzilay, an epidemiologist at the CDC.

“Norovirus accounts for about 50% of all foodborne outbreaks in the U.S.,” he noted.

The cases occurred among participants in 12 of 90 trips conducted by 16 rafting companies during the 3-week period.

Most rafting trips last from 2 to 14 days. Perishable food is carried in cold storage containers on each raft. Typical rafts carry six to eight people as well as a guide, and each raft carries a portable excrement storage container known as an “ammo can.”

Dr. Barzilay and his colleagues interviewed rafters who went on trips on which people became ill. An “ill rafter” was defined as a rafter or guide who suffered vomiting or diarrhea while on a rafting trip between Aug. 19 and Sept. 12, 2005. An “ill trip” was defined as a trip with three or more ill rafters. “Cases” were individuals who became ill within the first 48 hours of a trip, and controls were individuals who were not ill within 72 hours of the start of the trip or who were never ill.

“The mean incubation for norovirus is about 33 hours, so we looked at possible exposure to the virus on the launch date of any given trip,” Dr. Barzilay said. A review of 57 cases and 96 controls showed that cases were 7.3 times more likely than controls to have consumed deli meat. Deli meat was served for either lunch or dinner on the first day of each of the trips on which people became ill.

Three of five composite stool samples from the “ammo cans” on trips sponsored by two rafting companies tested positive for norovirus, as did two of four individual stool samples from ill rafters; all positive norovirus samples were of the same genetic sequence.

The rafters came from different geographic locations, and the ill trips did not use the same raft guides or equipment. All ill trips were launched by 5 of 16 rafting companies, and these 5 companies shared three food suppliers. Both chicken and beef from a plant that supplied meats to five rafting companies tested positive for norovirus, despite the fact that the meat was vacuum-packed and frozen at −10° F for 7–28 days before shipping.

While visiting the plant where the contamination was thought to originate, the CDC investigators learned that a food handler had become ill around the time that the deli meat for the rafting companies was processed. “He was most likely still shedding virus when he returned to work, and he cross-contaminated that meat,” Dr. Barzilay said.

“This is the first report of food product contaminated at the point of processing in a government-inspected plant,” he noted.

Physicians who see patients with foodborne illnesses should consider that food involved in disease outbreaks may have been contaminated at the point of processing, rather than the point of service.

“Although we often think of norovirus contamination occurring at point of service, we suspect that contamination can also occur at point of processing for prepackaged and ready-to-eat foods,” Dr. Barzilay said.

Norovirus is highly resilient, and it can survive on surfaces for extended periods of time, he noted. Food handlers who become ill should stay home from work for 24 hours after their symptoms resolve, he added.

ATLANTA — Just when you thought that prepackaged deli meat was safe, a gastroenteritis outbreak among river rafters in Colorado was traced to norovirus in prepackaged chicken and beef, Dr. Ezra J. Barzilay said at the International Conference on Emerging Infectious Diseases.

On Sept. 18, 2005, the National Park Service contacted the Centers for Disease Control and Prevention to report an outbreak of 136 cases of gastroenteritis in 3 weeks among rafters who participated in group trips on the Colorado River, said Dr. Barzilay, an epidemiologist at the CDC.

“Norovirus accounts for about 50% of all foodborne outbreaks in the U.S.,” he noted.

The cases occurred among participants in 12 of 90 trips conducted by 16 rafting companies during the 3-week period.

Most rafting trips last from 2 to 14 days. Perishable food is carried in cold storage containers on each raft. Typical rafts carry six to eight people as well as a guide, and each raft carries a portable excrement storage container known as an “ammo can.”

Dr. Barzilay and his colleagues interviewed rafters who went on trips on which people became ill. An “ill rafter” was defined as a rafter or guide who suffered vomiting or diarrhea while on a rafting trip between Aug. 19 and Sept. 12, 2005. An “ill trip” was defined as a trip with three or more ill rafters. “Cases” were individuals who became ill within the first 48 hours of a trip, and controls were individuals who were not ill within 72 hours of the start of the trip or who were never ill.

“The mean incubation for norovirus is about 33 hours, so we looked at possible exposure to the virus on the launch date of any given trip,” Dr. Barzilay said. A review of 57 cases and 96 controls showed that cases were 7.3 times more likely than controls to have consumed deli meat. Deli meat was served for either lunch or dinner on the first day of each of the trips on which people became ill.

Three of five composite stool samples from the “ammo cans” on trips sponsored by two rafting companies tested positive for norovirus, as did two of four individual stool samples from ill rafters; all positive norovirus samples were of the same genetic sequence.

The rafters came from different geographic locations, and the ill trips did not use the same raft guides or equipment. All ill trips were launched by 5 of 16 rafting companies, and these 5 companies shared three food suppliers. Both chicken and beef from a plant that supplied meats to five rafting companies tested positive for norovirus, despite the fact that the meat was vacuum-packed and frozen at −10° F for 7–28 days before shipping.

While visiting the plant where the contamination was thought to originate, the CDC investigators learned that a food handler had become ill around the time that the deli meat for the rafting companies was processed. “He was most likely still shedding virus when he returned to work, and he cross-contaminated that meat,” Dr. Barzilay said.

“This is the first report of food product contaminated at the point of processing in a government-inspected plant,” he noted.

Physicians who see patients with foodborne illnesses should consider that food involved in disease outbreaks may have been contaminated at the point of processing, rather than the point of service.

“Although we often think of norovirus contamination occurring at point of service, we suspect that contamination can also occur at point of processing for prepackaged and ready-to-eat foods,” Dr. Barzilay said.

Norovirus is highly resilient, and it can survive on surfaces for extended periods of time, he noted. Food handlers who become ill should stay home from work for 24 hours after their symptoms resolve, he added.

ATLANTA — Just when you thought that prepackaged deli meat was safe, a gastroenteritis outbreak among river rafters in Colorado was traced to norovirus in prepackaged chicken and beef, Dr. Ezra J. Barzilay said at the International Conference on Emerging Infectious Diseases.

On Sept. 18, 2005, the National Park Service contacted the Centers for Disease Control and Prevention to report an outbreak of 136 cases of gastroenteritis in 3 weeks among rafters who participated in group trips on the Colorado River, said Dr. Barzilay, an epidemiologist at the CDC.

“Norovirus accounts for about 50% of all foodborne outbreaks in the U.S.,” he noted.

The cases occurred among participants in 12 of 90 trips conducted by 16 rafting companies during the 3-week period.

Most rafting trips last from 2 to 14 days. Perishable food is carried in cold storage containers on each raft. Typical rafts carry six to eight people as well as a guide, and each raft carries a portable excrement storage container known as an “ammo can.”

Dr. Barzilay and his colleagues interviewed rafters who went on trips on which people became ill. An “ill rafter” was defined as a rafter or guide who suffered vomiting or diarrhea while on a rafting trip between Aug. 19 and Sept. 12, 2005. An “ill trip” was defined as a trip with three or more ill rafters. “Cases” were individuals who became ill within the first 48 hours of a trip, and controls were individuals who were not ill within 72 hours of the start of the trip or who were never ill.

“The mean incubation for norovirus is about 33 hours, so we looked at possible exposure to the virus on the launch date of any given trip,” Dr. Barzilay said. A review of 57 cases and 96 controls showed that cases were 7.3 times more likely than controls to have consumed deli meat. Deli meat was served for either lunch or dinner on the first day of each of the trips on which people became ill.

Three of five composite stool samples from the “ammo cans” on trips sponsored by two rafting companies tested positive for norovirus, as did two of four individual stool samples from ill rafters; all positive norovirus samples were of the same genetic sequence.

The rafters came from different geographic locations, and the ill trips did not use the same raft guides or equipment. All ill trips were launched by 5 of 16 rafting companies, and these 5 companies shared three food suppliers. Both chicken and beef from a plant that supplied meats to five rafting companies tested positive for norovirus, despite the fact that the meat was vacuum-packed and frozen at −10° F for 7–28 days before shipping.

While visiting the plant where the contamination was thought to originate, the CDC investigators learned that a food handler had become ill around the time that the deli meat for the rafting companies was processed. “He was most likely still shedding virus when he returned to work, and he cross-contaminated that meat,” Dr. Barzilay said.

“This is the first report of food product contaminated at the point of processing in a government-inspected plant,” he noted.

Physicians who see patients with foodborne illnesses should consider that food involved in disease outbreaks may have been contaminated at the point of processing, rather than the point of service.

“Although we often think of norovirus contamination occurring at point of service, we suspect that contamination can also occur at point of processing for prepackaged and ready-to-eat foods,” Dr. Barzilay said.

Norovirus is highly resilient, and it can survive on surfaces for extended periods of time, he noted. Food handlers who become ill should stay home from work for 24 hours after their symptoms resolve, he added.

DENVER — Phobic anxiety was significantly associated with both ventricular arrhythmia and mortality in coronary artery disease patients during a median 3-year follow-up, Lana Watkins, Ph.D., said at the annual meeting of the American Psychosomatic Society.

The relationship between sudden cardiac death and phobic anxiety in particular has not been well studied, Dr. Watkins noted. She and her colleagues at Duke University Medical Center in Durham, N.C., evaluated 941 adult patients who were being treated for coronary artery disease. A majority of these patients were white males. About a third of the patients did not have high school diplomas, and smoking and obesity were common among patients in the study.

The highest number of arrhythmias occurred among those with the highest levels of phobic anxiety based on the Crown-Crisp index, which rates eight types of phobias, including fear of heights, crowds, and closed spaces.

Overall, the highest tertile of phobic anxiety scores had twice as many females as males, and a higher level of phobic anxiety was significantly associated with female sex, minority status, increased body mass index, and younger age.

Despite the finding of an association between phobic anxiety and ventricular arrhythmias, no significant relationship was found between phobic anxiety and sudden cardiac death, Dr. Watkins noted.

During a follow-up period, 134 patients died, and 46 of these met the criteria for sudden cardiac death. Sudden cardiac death was defined as death within 72 hours of collapse, in order to account for deaths of patients who lived alone. However, mortality was highest among patients with high levels of phobic anxiety, he said.

The predictability of phobic anxiety for both mortality and an increased risk of ventricular arrhythmias was maintained in a regression analysis after adjustment for other predictors of mortality, including age, gender, education level, and comorbidities.

DENVER — Phobic anxiety was significantly associated with both ventricular arrhythmia and mortality in coronary artery disease patients during a median 3-year follow-up, Lana Watkins, Ph.D., said at the annual meeting of the American Psychosomatic Society.

The relationship between sudden cardiac death and phobic anxiety in particular has not been well studied, Dr. Watkins noted. She and her colleagues at Duke University Medical Center in Durham, N.C., evaluated 941 adult patients who were being treated for coronary artery disease. A majority of these patients were white males. About a third of the patients did not have high school diplomas, and smoking and obesity were common among patients in the study.

The highest number of arrhythmias occurred among those with the highest levels of phobic anxiety based on the Crown-Crisp index, which rates eight types of phobias, including fear of heights, crowds, and closed spaces.

Overall, the highest tertile of phobic anxiety scores had twice as many females as males, and a higher level of phobic anxiety was significantly associated with female sex, minority status, increased body mass index, and younger age.

Despite the finding of an association between phobic anxiety and ventricular arrhythmias, no significant relationship was found between phobic anxiety and sudden cardiac death, Dr. Watkins noted.

During a follow-up period, 134 patients died, and 46 of these met the criteria for sudden cardiac death. Sudden cardiac death was defined as death within 72 hours of collapse, in order to account for deaths of patients who lived alone. However, mortality was highest among patients with high levels of phobic anxiety, he said.

The predictability of phobic anxiety for both mortality and an increased risk of ventricular arrhythmias was maintained in a regression analysis after adjustment for other predictors of mortality, including age, gender, education level, and comorbidities.

DENVER — Phobic anxiety was significantly associated with both ventricular arrhythmia and mortality in coronary artery disease patients during a median 3-year follow-up, Lana Watkins, Ph.D., said at the annual meeting of the American Psychosomatic Society.

The relationship between sudden cardiac death and phobic anxiety in particular has not been well studied, Dr. Watkins noted. She and her colleagues at Duke University Medical Center in Durham, N.C., evaluated 941 adult patients who were being treated for coronary artery disease. A majority of these patients were white males. About a third of the patients did not have high school diplomas, and smoking and obesity were common among patients in the study.

The highest number of arrhythmias occurred among those with the highest levels of phobic anxiety based on the Crown-Crisp index, which rates eight types of phobias, including fear of heights, crowds, and closed spaces.

Overall, the highest tertile of phobic anxiety scores had twice as many females as males, and a higher level of phobic anxiety was significantly associated with female sex, minority status, increased body mass index, and younger age.

Despite the finding of an association between phobic anxiety and ventricular arrhythmias, no significant relationship was found between phobic anxiety and sudden cardiac death, Dr. Watkins noted.

During a follow-up period, 134 patients died, and 46 of these met the criteria for sudden cardiac death. Sudden cardiac death was defined as death within 72 hours of collapse, in order to account for deaths of patients who lived alone. However, mortality was highest among patients with high levels of phobic anxiety, he said.

The predictability of phobic anxiety for both mortality and an increased risk of ventricular arrhythmias was maintained in a regression analysis after adjustment for other predictors of mortality, including age, gender, education level, and comorbidities.

Quetiapine was at least as effective as divalproex in alleviating manic symptoms in adolescents in a randomized, double-blind pilot study, wrote Dr. Melissa P. DelBello and her colleagues at the University of Cincinnati, Ohio.

The 28-day pilot study of 50 adolescents aged 12–18 years was the first known to directly compare an atypical antipsychotic with an antiepileptic in adolescents with mania, the researchers noted (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:305–13). The study was supported by a grant from AstraZeneca Pharmaceuticals, which markets quetiapine (Seroquel), and is one of the many companies from which Dr. DelBello has received research funding.

The adolescents who received quetiapine started with a 100-mg dose on the first day, which was increased to 400 mg by days 4–7, up to a maximum of 600 mg/day. Those who received divalproex started with a 20-mg/kg dose on the first day, which was increased to achieve serum valproic acid levels of 80–120 μg/mL. At the end of the study, the mean doses were 412 mg/day to 422 mg/day in the quetiapine group, and a valproic acid level of 101 μg/mL in the divalproex group.

Overall, patients in both groups showed statistically significant improvements in their scores on the Young Mania Rating Scale at the end of the study. The response was quicker among the quetiapine patients, compared with divalproex patients, and the overall response rate on the Clinical Global Impressions-Bipolar Version-Improvement scale was significantly greater in the quetiapine group than in the divalproex group (72% vs. 40%).

Quetiapine was at least as effective as divalproex in alleviating manic symptoms in adolescents in a randomized, double-blind pilot study, wrote Dr. Melissa P. DelBello and her colleagues at the University of Cincinnati, Ohio.

The 28-day pilot study of 50 adolescents aged 12–18 years was the first known to directly compare an atypical antipsychotic with an antiepileptic in adolescents with mania, the researchers noted (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:305–13). The study was supported by a grant from AstraZeneca Pharmaceuticals, which markets quetiapine (Seroquel), and is one of the many companies from which Dr. DelBello has received research funding.

The adolescents who received quetiapine started with a 100-mg dose on the first day, which was increased to 400 mg by days 4–7, up to a maximum of 600 mg/day. Those who received divalproex started with a 20-mg/kg dose on the first day, which was increased to achieve serum valproic acid levels of 80–120 μg/mL. At the end of the study, the mean doses were 412 mg/day to 422 mg/day in the quetiapine group, and a valproic acid level of 101 μg/mL in the divalproex group.

Overall, patients in both groups showed statistically significant improvements in their scores on the Young Mania Rating Scale at the end of the study. The response was quicker among the quetiapine patients, compared with divalproex patients, and the overall response rate on the Clinical Global Impressions-Bipolar Version-Improvement scale was significantly greater in the quetiapine group than in the divalproex group (72% vs. 40%).

Quetiapine was at least as effective as divalproex in alleviating manic symptoms in adolescents in a randomized, double-blind pilot study, wrote Dr. Melissa P. DelBello and her colleagues at the University of Cincinnati, Ohio.

The 28-day pilot study of 50 adolescents aged 12–18 years was the first known to directly compare an atypical antipsychotic with an antiepileptic in adolescents with mania, the researchers noted (J. Am. Acad. Child Adolesc. Psychiatry 2006;45:305–13). The study was supported by a grant from AstraZeneca Pharmaceuticals, which markets quetiapine (Seroquel), and is one of the many companies from which Dr. DelBello has received research funding.

The adolescents who received quetiapine started with a 100-mg dose on the first day, which was increased to 400 mg by days 4–7, up to a maximum of 600 mg/day. Those who received divalproex started with a 20-mg/kg dose on the first day, which was increased to achieve serum valproic acid levels of 80–120 μg/mL. At the end of the study, the mean doses were 412 mg/day to 422 mg/day in the quetiapine group, and a valproic acid level of 101 μg/mL in the divalproex group.

Overall, patients in both groups showed statistically significant improvements in their scores on the Young Mania Rating Scale at the end of the study. The response was quicker among the quetiapine patients, compared with divalproex patients, and the overall response rate on the Clinical Global Impressions-Bipolar Version-Improvement scale was significantly greater in the quetiapine group than in the divalproex group (72% vs. 40%).

More than 25% of children and adolescents with obsessive-compulsive disorder had comorbid attention-deficit hyperactivity disorder in a consecutive study of 94 patients, reported Dr. Gabriele Masi and her associates at the Scientific Institute of Child Neurology and Psychiatry in Calambrone, Pisa (Italy).

Overall, 88% of the 24 comorbid patients were male, and the average age of onset of obsessive-compulsive disorder (OCD) was slightly higher among patients with comorbid attention-deficit hyperactivity disorder (ADHD). Several disruptive behavior disorders—oppositional defiant disorder, bipolar disorder, and tic disorder—were significantly more common among comorbid patients.

The 3-year study included 65 males and 29 females aged 8–18 years. All of the patients were undergoing treatment for OCD with selective serotonin reuptake inhibitors, such as fluoxetine and sertraline (Zoloft), but none was being treated for ADHD with psychostimulants (Compr. Psychiatry 2006;47:42–7).

In patients with comorbid ADHD, functional baseline impairment was higher, and improvement in symptoms after 6 months of follow-up was lower. Patients with co-occurring OCD-ADHD were more frequently male (88% vs. 62%). In addition, patients with OCD and ADHD had higher rates of comorbid disorders, such as various anxiety disorders.

There were no significant differences between patients with and without comorbid ADHD with regard to OCD behaviors involving ordering, aggression, contamination, and hoarding.

The study results suggest a need for ADHD screening in all children and adolescents with OCD, the investigators wrote.

More than 25% of children and adolescents with obsessive-compulsive disorder had comorbid attention-deficit hyperactivity disorder in a consecutive study of 94 patients, reported Dr. Gabriele Masi and her associates at the Scientific Institute of Child Neurology and Psychiatry in Calambrone, Pisa (Italy).

Overall, 88% of the 24 comorbid patients were male, and the average age of onset of obsessive-compulsive disorder (OCD) was slightly higher among patients with comorbid attention-deficit hyperactivity disorder (ADHD). Several disruptive behavior disorders—oppositional defiant disorder, bipolar disorder, and tic disorder—were significantly more common among comorbid patients.

The 3-year study included 65 males and 29 females aged 8–18 years. All of the patients were undergoing treatment for OCD with selective serotonin reuptake inhibitors, such as fluoxetine and sertraline (Zoloft), but none was being treated for ADHD with psychostimulants (Compr. Psychiatry 2006;47:42–7).

In patients with comorbid ADHD, functional baseline impairment was higher, and improvement in symptoms after 6 months of follow-up was lower. Patients with co-occurring OCD-ADHD were more frequently male (88% vs. 62%). In addition, patients with OCD and ADHD had higher rates of comorbid disorders, such as various anxiety disorders.

There were no significant differences between patients with and without comorbid ADHD with regard to OCD behaviors involving ordering, aggression, contamination, and hoarding.

The study results suggest a need for ADHD screening in all children and adolescents with OCD, the investigators wrote.

More than 25% of children and adolescents with obsessive-compulsive disorder had comorbid attention-deficit hyperactivity disorder in a consecutive study of 94 patients, reported Dr. Gabriele Masi and her associates at the Scientific Institute of Child Neurology and Psychiatry in Calambrone, Pisa (Italy).

Overall, 88% of the 24 comorbid patients were male, and the average age of onset of obsessive-compulsive disorder (OCD) was slightly higher among patients with comorbid attention-deficit hyperactivity disorder (ADHD). Several disruptive behavior disorders—oppositional defiant disorder, bipolar disorder, and tic disorder—were significantly more common among comorbid patients.

The 3-year study included 65 males and 29 females aged 8–18 years. All of the patients were undergoing treatment for OCD with selective serotonin reuptake inhibitors, such as fluoxetine and sertraline (Zoloft), but none was being treated for ADHD with psychostimulants (Compr. Psychiatry 2006;47:42–7).

In patients with comorbid ADHD, functional baseline impairment was higher, and improvement in symptoms after 6 months of follow-up was lower. Patients with co-occurring OCD-ADHD were more frequently male (88% vs. 62%). In addition, patients with OCD and ADHD had higher rates of comorbid disorders, such as various anxiety disorders.

There were no significant differences between patients with and without comorbid ADHD with regard to OCD behaviors involving ordering, aggression, contamination, and hoarding.

The study results suggest a need for ADHD screening in all children and adolescents with OCD, the investigators wrote.

The adult formula of the tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) can be given to children and adolescents starting at 18 months after a children's formula tetanus and diphtheria vaccine, said Dr. Scott A. Halperin of Dalhousie University, Halifax, Nova Scotia, and his colleagues.

Prior recommendations for a 10-year waiting period between doses of the tetanus and diphtheria toxoid-containing vaccine for infants and young children (TD) or the vaccine for older children and adults (Td) had been based on effectiveness rather than a lack of safety information, the investigators noted.

Concerns about the timing of vaccinations and adverse events prompted an open-label clinical trial including 7,156 children in grades 3–12 who received Tdap at time intervals ranging from 18 months to 9 years after their previous vaccinations with TD, Td, or diphtheria-tetanus-acellular pertussis (DTaP).

Tdap was generally well tolerated regardless of the time elapsed since the previous vaccination. Data on fever, injection site erythema, swelling, and pain were solicited for 14 days after immunization, and unsolicited adverse events were recorded for 28 days (Pediatr. Infect. Dis. J. 2006;25:195–200).

Overall, more than 80% of the children in each time interval reported injection site pain, but this was not significantly different from pain reports in children who were vaccinated 10 years after a previous immunization. Injection site erythema was slightly increased among children whose previous vaccine had been DTaP, but not among those whose previous vaccine had been Td. The four reported serious adverse events included one case each of asthma, bronchospasm, syncope, and juvenile onset diabetes mellitus, but none of these were attributed to Tdap.

The adult formula of the tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) can be given to children and adolescents starting at 18 months after a children's formula tetanus and diphtheria vaccine, said Dr. Scott A. Halperin of Dalhousie University, Halifax, Nova Scotia, and his colleagues.

Prior recommendations for a 10-year waiting period between doses of the tetanus and diphtheria toxoid-containing vaccine for infants and young children (TD) or the vaccine for older children and adults (Td) had been based on effectiveness rather than a lack of safety information, the investigators noted.

Concerns about the timing of vaccinations and adverse events prompted an open-label clinical trial including 7,156 children in grades 3–12 who received Tdap at time intervals ranging from 18 months to 9 years after their previous vaccinations with TD, Td, or diphtheria-tetanus-acellular pertussis (DTaP).

Tdap was generally well tolerated regardless of the time elapsed since the previous vaccination. Data on fever, injection site erythema, swelling, and pain were solicited for 14 days after immunization, and unsolicited adverse events were recorded for 28 days (Pediatr. Infect. Dis. J. 2006;25:195–200).

Overall, more than 80% of the children in each time interval reported injection site pain, but this was not significantly different from pain reports in children who were vaccinated 10 years after a previous immunization. Injection site erythema was slightly increased among children whose previous vaccine had been DTaP, but not among those whose previous vaccine had been Td. The four reported serious adverse events included one case each of asthma, bronchospasm, syncope, and juvenile onset diabetes mellitus, but none of these were attributed to Tdap.

The adult formula of the tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) can be given to children and adolescents starting at 18 months after a children's formula tetanus and diphtheria vaccine, said Dr. Scott A. Halperin of Dalhousie University, Halifax, Nova Scotia, and his colleagues.

Prior recommendations for a 10-year waiting period between doses of the tetanus and diphtheria toxoid-containing vaccine for infants and young children (TD) or the vaccine for older children and adults (Td) had been based on effectiveness rather than a lack of safety information, the investigators noted.

Concerns about the timing of vaccinations and adverse events prompted an open-label clinical trial including 7,156 children in grades 3–12 who received Tdap at time intervals ranging from 18 months to 9 years after their previous vaccinations with TD, Td, or diphtheria-tetanus-acellular pertussis (DTaP).

Tdap was generally well tolerated regardless of the time elapsed since the previous vaccination. Data on fever, injection site erythema, swelling, and pain were solicited for 14 days after immunization, and unsolicited adverse events were recorded for 28 days (Pediatr. Infect. Dis. J. 2006;25:195–200).

Overall, more than 80% of the children in each time interval reported injection site pain, but this was not significantly different from pain reports in children who were vaccinated 10 years after a previous immunization. Injection site erythema was slightly increased among children whose previous vaccine had been DTaP, but not among those whose previous vaccine had been Td. The four reported serious adverse events included one case each of asthma, bronchospasm, syncope, and juvenile onset diabetes mellitus, but none of these were attributed to Tdap.